NSG 3800/ NSG3800 Exam 4 V1 – Adult Health II | 2026/2027 Update | Galen | Latest Questions & Verified Answers

NSG 3800/ NSG3800 Exam 4 V1 – Adult Health II | 2026/2027 Update | Galen | Latest Questions & Verified Answers s/s of biliary colic Pain that increases 15min after eating and can last up too an hour Common S/S Cholecystitis RUQ pain that radiates too the shoulder and back, acute fever , dark urine. What is Addisons Disease and how do we treat it? Not enough Cortisol, Treat with steroids. Steroid use has a risk of high blood sugar and depress the immune system What is Cushing's syndrome? excessive cortisol production Dexamethasone Suppression test (Cushings) Do it at night and check the results in the morning Side effects of Levothyroxine Increase HR, DO NOT GIVE if HR is above 100, can lead to an acute coronary syndrome Lymphadenopathy palpable cervical, supraclavicular & mediastinal nodes What is a complication of Hypothyroidism Myxedema What to do for pt that is high risk of myxedema coma Keep them warm, give levothyroxine, monitor neuro status and airway Priority for Pt in a Myxedema Coma Airway! Keep suction and vent in room What is a complication of Hyperthyroidism Thyroid storm What is S/S of thyroid storm and what do we do? Development of a rapid onset fever, increased HR, possible crackles in lungs, monitor their cardiac status and call MD What do we monitor after a thyroidectomy Serum Calcium & BP, IF POSITIVE TROUSSEAU GIVE CALCIUM GLUCONATE What meds can impact thyroid studies? Beta Blockers (propanol/metoprolol) , anything that affects the heart rate , Lasix/Diuretics, NSAIDS Wound care teaching post Laparoscopic Cholecystectomy Don’t remove glue or adhesive strips, will fall off by themselves Education for foods to avoid pre/post cholecystectomy Dairy & Fatty Foods (acceptable foods are baked fish, rice, green beans) Where is Cholecystitis Pain ? RUQ that radiates to RIGHT shoulder (can radiate to the center of the entire abdomen) Cholecystitis w stones blocking the bile duct , what CM ? Dark Urine & Clay-light colored stool ERCP: what should you include in recovery teaching? NPO until gag/swallow reflex returns (Ice chips) & they need a ride home d/t conscious sedation Laparoscopic Cholecystitis dont remove glue or strips- will fall off on their own pt with cholecystitis/ chloelithiasis has gallbladder pain, biliary colic, restless, severe exhaustion & diaphoretic. What do you do? Stay with patient and call doctor Complications of Liver Biopsy #1-Bleeding/hemorrhage into periotoneal cavity (most important!!) PERITONITIS Peritonitis (complication of liver biopsy) S/S Tachycardia, RIGID boardlike abdomen, low BP, no bowel sounds Pt w liver failure whos dehydrated and possible blood loss, What are labs?? LOW hematocrit, HIGH BUN, HIGH sodium (take vitals) what happens to the skin in liver disease Dry , Jaundice (bilirubin) Skin care for Jaundice lots of itching, so use mild soaps and creams How is Hep A transmitted (Angela) Fecal-Oral Contaminated Food & water (shrimp /shellfish) people who eat at buffets at risk and people who travel internationally Whos at risk for Hep B (Brittany) Risky sexual behaviors, multiple partners, IV drug use, blood exposure, mucous membranes RX TX lamivudine for Hep B, what are adverse effects ? Pancreatitis monitor for s/s like elevated pancreatic enzymes (amylase) & weightloss Hep B education for new nurse Standard Precautions, Do not recap needles, avoid needle sticks, HAND HYGINE, and Vaccine Hep C is asymptomatic, what do we educate on? avoid risky behavior, MEDICATION ADHERENCE to antivirals even if they feel ok How is HEP C transmitted (carly) sewage contamination prevention : hand hygiene, sanitation practices, drink bottled water RX proplthiouracil (PTU) for Hyperthyroidism , foods to limit Soybean flour, Walnuts, Cotton seed oil, dietary flour Pt on radioactive iodine therapy , what S/S do we report IMMEDIATELY Thyroid Storm- elevation in temp What to report for thyroidectomy Thyroid Storm, S/S of hypocalcemia ( parathyroid may of accidentally been removed) give IV calcium gluconate Chemo drug/blood precautions Double layer powder free gloves Inner glove worn under gown cuff Long sleeve disposable gown Any linens contaminated placed in biohazard bag. Can we delegate a transfer of a patient with multiple myeloma to a PCA? NO- fragile bones and VERY at risk for bone fractures PT with AIDS and pneumocystis pneumonia what is priority Inaffective airway clearance AIDS DX of CD4+ count Under 200 Enfuvirtide (T-20) dietary counseling Take this medication in disregard to meals (doesn't matter) Tx for hypothyroidism Thyroid Replacement -Levothyroxine sodium -Synthroid Levothyroxine teaching Avoid calcium consumption w/in 3 hours of taking med Doesnt absorb well with mag containing antacids Do not take with digoxin/ warfrin Take on an empty stomach in the am. If on anticoagulants pt may need to decrease dose (RF bleeding) Medication increases TSH (Thyroid Stimulating Hormone) RN intervention for Diarrhea with HIV Admin Anti-diarrheal med as prescribed , don't increase fluids for dehydration bc will just worsen diarrhea Efavirenz Can cause a false positive result for benzodiazepine HIV infection has subsided ,and an equilibrium now exists between HIV levels and the clients immune response what phase is this Viral Set Point Priority Discharge education for HIV Hand Hygiene Myxedema is a complication of what, and what are the s/s? Hypothyroidism -Decreased LOC -Low BP -Low Pulse -May need ventilatory support for resp. depression -severe lethargy -drowsiness/ memory issues /poor attention span Myxedema Coma S/S & TX Hypothermia & Unconscious -IV thyroid replacement (Levothyroxine) with extreme caution b/c of potential for altered metabolism and excretion , depressed metabolic rate and resp. status What is a adverse affect of meloxicam ? GI bleeding gallbladder ultrasound teaching NPO midnight before Gallbladder Disease Post surgery Complication to immediately report Rigid board like abdomen ERCP (endoscopic retrograde cholangiopancreatography) complications Bleeding and Perforation laparoscopic cholecystectomy complication bile duct injury UDCA (ursodeoxycholic acid) for gallstones Pt on med for 6-12 months Elderly adult w gallstones will exhibit what s/s of septic shock Variceal bleeding RX TX IV admin of OCTREOTIDE #1 priority for patients of Leukemias Infection status Multiple Myeloma S/S HYPERCALCEMIA (dehydration/constipation, altered mental status) Bence Jones BONE FRACTURES Decreased bone density kidney failure lower back/rib pain Bence Jones is associated with what? Multiple Myeloma Most presenting Hyperthyroidism Symptom Nervousness/emotionally hyperexcitable, irritable, apprehensive (think Hyper) Unique S/S with Hyperthyroidism Heat Intolerance Exophthalmos (protruding eyes) Dysrhythmias (palpations/rapid pulse) Weight loss even with increase appetite Thyroid Storm Most common cause of Hyperthyroidism Graves Disease What do we monitor after a Thyroidectomy serum Calcium and BP Thyroid Storm Rapid fever , Tachycardia, Systolic HTN, Altered mental state, chest pain, palpitations, abdominal pain, Weight loss, Diarrhea, delirium, psychosis. DX of Thyroid Storm elevated T3 & T4 Decreased TSH Goiter TX of thyroid Storm NO asprin Call MD -if crackles in lungs monior pt and tell MD about temp and HR Pt is at Risk for myxedema , interventions? Keep them warm admin Levothyroxine monitor neuro AIRWAY (keep vent & suction on hand d/t coma) dx of hyperparathyroidism Positive Chvostek Sign Positive Trousseau Sign Patient has a Thyroidectomy , but a Positive Trousseau sign Give calcium gluconate Meds that will affect a Thyroid Study Beta Blockers (lol drugs) Lasix/ Diuretics NSAIDS Main Risk Factor for Cushing's Syndrome Excessive Corticosteroid use Cushing's syndrome S/S Moon Face Truncal obesity Buffalo Hump (kyphosis) HTN Thin skin easily bruised/ acne Purple Strae abd. obesity Peptic Ulcers Osteoporosis Hirsutism urinary cortisol (cushings) needs 24 hr collection TX for Addisons hint: what causes cushings Steroids dx of hyperparathyroidism & Complications DX: elevated parathormone Complications: kidney stones & nephralisis hyperparathyroidism TX #1 parathyroidectomy Fluids Encourage Walking ! AVOID Thiazide Diuretics Prune juice for constipation Parathyroidectomy post op Trach Kit & Suction at bedside ! Calcium gluconate IV for emergency (give slowly and watch heart) Put pt on heart monitor Educate on High vit D & Calcium diet Hypoparathyroidism Interventions Vitamin D2 or D3 (calcium needs Vitamin D) Avoid milk, eggs, and spinach bc high in phos Calcium gluconate Amphojel given after meal to bind to phos Hyperparathyroidism increased PTH (Puts The calcium High) S/S of Hypercalcemia (moans,groans,stones) Constipation Psychosis Bone pain (demineralization) HTN Low Phosphate (give oral phos short term only) Addisons Disease ADD steroids d/t ABBsense ADDSS Added pigmentation (hyper/bronzed) Decreased weight Decreased BP/SUGAR/ Sodium (low) Salt craving Cushing's Syndrome think CUSHION of steroids (big & too much) CUSH Cushion (buffalo hump/ moon face/ truncal obesity) Unusual hair growth Skin/Slow (Purple striae) (slow healing aka BONE FRACTURE) High (sugar/BP/weight) What is another name for Hyperthyroidism Graves disease! (think GAINS disease) high energy TX for Hyperthyroidism Radioactive Iodine -do not use same toilet as family -do not wash clothes with families -not for pregnant pt/ dont go around pregnant ppl -plastic plates & utinsils - laxative for 3 days after - pee sitting down do you dont splash Hyperthyroidism Teaching High calorie meals High Protein Carbs Frequent meals & snacks AVOID -high fiber -no caffine! -spicy food In what scenario would we place a Endotracheal Intubation set up in the patients room? Risk of Myxedema Coma!!! (Hypothyroidism) hint- everything is too low and slow OR post Tracheostomy ! RF for Myxedema Coma Post thyroidectomy Abrupt stop of levothyroxine Hypothyroidism Interventions Low Calories Low cholesterol & sat fats FREQUENT rest periods Levothyroxine is given for what? Education? Hypothyroidism (think levO for HypO because its LOW) LEVO Lifelong drug Early morning/ Empty stomach!!! Very hyper (report aggitation and confusion) O the babies fine! (pragnant safe) ----NEVER abrupty stop!----slow onset needs 3-4weeks What meds do we not give a patient with hypothyroidism Sedatives (benzos & pam drugs) Narcotics (vicodin/morphine/diaudid/fentanyl) Radioactive Iodine Uptake (RAIU) teaching -Before: need negative pregnancy test remove jewelry & dentures 5-7 days before hold antithyroid meds Tell pt they will be awake , there's no sedation NPO 2-4hrs before & 1-2 hrs after -After: AVOID everyone for a few days Flush toilet 3 times No kissing Wash laundry sep. stay away from babies What is CREST syndrome and when do we see it? with Scleroderma What is chemotherapy used for? To destroy cancer cells (even non-cancerous cells). How is chemotherapy administered? It can be infused orally or through a central line. What should be done if extravasation occurs during chemotherapy? It can be minimized with an antidote. How often must WBC be drawn during chemotherapy? Daily. What should you do if WBC count is between during chemotherapy? Call the PCP (Primary Care Provider). HIV/ WASTING SYNDROME monitor weight electrolytes notify if K is les then 3 What should be monitored in patients with Hodgkin's disease? Low PO2 levels What skin care considerations are important for patients with Hodgkin's disease? Skin care due to pruritis and jaundice What should patients with Hodgkin's disease avoid, especially when receiving radiation treatment? Sun exposure What type of infections are patients with Hodgkin's disease at risk for? Opportunistic infections (OIs) What is a recommended management strategy for multiple myeloma? Increase fluid intake to increase urine output. What should be monitored in advanced multiple myeloma? Monitor for fracture or spinal cord compression. What is considered an emergency in advanced multiple myeloma? Fracture or spinal cord compression. Non-Hodgkin's Lymphoma patients can go into remission and resume all ADLS with an exercise program 5 days for 30 minutes patient teaching take medications What does PCP stand for in a medical context? Pneumocystis pneumonia What type of infections does PCP primarily cause? Infections in the lungs In an AIDS patient, what are common symptoms of PCP? Low oxygen levels and cough How does a patient with PCP typically appear? The patient will appear ill What medication is commonly used for symptom management in rheumatoid arthritis? Prednisone What should be monitored when a patient is taking prednisone? Blood sugar What is an important step in managing medications for rheumatoid arthritis? Review medications What should be encouraged alongside activity for patients with rheumatoid arthritis? Scheduled rest areas What type of equipment can assist patients with activities of daily living (ADLs) in rheumatoid arthritis? Adaptive equipment SLE (LUPUS) Alert doc with chest pain especially with a deep breath remind use of sunscreen when outside TB Dx is sputum specimens chest x ray and always check temp What is Addison's disease? Adrenocortical insufficiency What type of diet is recommended for Addison's disease? High carb/high protein diet What type of exercise should be avoided in Addison's disease? Strenuous exercise What is a key consideration when taking medications for Addison's disease? Medications are lifelong What should be monitored due to medications in Addison's disease? Immunosuppression secondary to steroids Which steroid is commonly used in the treatment of Addison's disease? Hydrocortisone steriods Cushing disease usually with elevated BP dexamethasone challenge test myxedema coma monitor breathing must have suction equipment at bed side Thyroid disease monitor levels: TSH T4 give medications monitor heart increases workload Medications that can interfere with thyriod studies lithium, lisinopril, ASA, lasix, notify provider if patient is on these medications hyper thyroid disease acute findings: increased peripheral pulses lung crackles increase hyperparathyriodism patient is usually oblivious monitor for flank pain: contact PCP thyroidectomy post op monitor for tetany or muscle spams will give calcium gluconate for low calcium- chovecks or trousseaus thyroid storm monitor for increasing temperature especially after radioactive iodine therapy or surgery if increasing temperature develops report to PCP ASAP HAV oral fecal transmission precaution when handling foods increase handwashing What is a common symptom of HBV? Poor appetite How is HBV transmitted? Through blood or body fluids What are two risk factors for HBV transmission? IV drug use and sexual contact What should be avoided until HBV test results are negative? Sexual contact What type of diet is recommended for someone with HBV? High carb, low fat diet What substance should be avoided in HBV management? Alcohol What should be used during sexual contact if HBV status is unknown? A barrier method What type of substances should be avoided due to liver toxicity in HBV? Liver toxic substances HCV medications available for treatment with 99% cure must take as prescribed Hep E similar to HAV hand hygiene oral-fecal spread (contact) avoid alcohol time limited What is cholecystitis? Infected gallbladder What symptom may be present in cholecystitis? Elevated temperature What type of pain is associated with cholecystitis? RUQ pain What type of diet is recommended for someone with cholecystitis? Low fat high protein diet What should be avoided in the diet of someone with cholecystitis? All alcohol What type of foods should be avoided in cholecystitis? Gas producing foods What should you monitor after a laparoscopic cholecystectomy? Temperature What should you do if the temperature elevates after a laparoscopic cholecystectomy? Inform the surgeon What type of foods should be avoided after a laparoscopic cholecystectomy? Fatty foods What activity helps with the reabsorption of gas after a laparoscopic cholecystectomy? Walking What will happen to the steri strips after a laparoscopic cholecystectomy? They will fall off ERCP invasive monitor for temperature spike post procedure may indicate perforation, or complication liver dysfunction may present with malaise jaundice with increased abdominal girth inquire about EtOH history amount per day week and time frame avoid trauma due to increased bleeding tendencies give soft tooth brush and electric razor general coag times are abnormal with liver dysfunction PT, INR indicates prolonged bleeding Cook at a local restaurant with Hep A which instructions should the nurse give to household members and sexual contacts of the client? We will administer immunoglobin injections to all household members and sexual partners nurse is caring for a client who has acute cholecystitis dinner tray which food selection causes for a follow up bacon cheeseburger, casserole and chocolate milk client who has liver disease and has marked hypoalbuminemia with serum albumin at 2.4 which assessment finding should be expected? jaundice and fluid retention risk of contracting hep b which is the education point the nurse should include all personnel must wear gloves when handling blood or body fluids nurse is caring for a client who is scheduled for an ERCP in the morning. Which indicate a need for additional teaching. I will avoid eating or drinking for 1-2 days after the procedure the nurse is admitting someone with suspected acute cholecystitis the nurse should assess for? episodic upper abdominal pain with dark or brown colored urine nurse is teaching a client about self-management with hep b which statement should be included take frequent rest periods through out the day nursing is educating a client with hep c about care at home what should be included? take antiviral meds as prescribed the nurse is presenting health education on hep E which of the following measures should the nurse recommended for preventing infection? using hand hygiene to avoid fecal oral transmission the nurse is caring for a who presents with cholelithiasis is now suspected of developing biliary colic. 12 hours after admission the client becomes very restless pale and diaphoretic and reporting severe exhaustion which should the client do next stay with the patient and call the PCP the nurse is caring for a client who presents with liver dysfunction, a low serum fibrinogen level, and prolonged prothrombin time (pt) which of the following actions should the nurse take. provide a soft toothbrush the nurse manager is teaching a group of newly hired nurses about preventive measures for contracting hep B which of the following measures should the nurse report vaccine and hep B immune globulin education to a client who is traveling to a non-industrialized country about the prevention of viral hep which statement needs additional teaching? I will take daily antiviral medication the nurse is working in the ed and is assessing a client who has presented with reports of malaise. The nurse's assessment reveals jaundice and increased abdominal girth. which of the following is the most important for the nurse to ask the client. how many alcoholic drinks would you say you consume in a week lab results for a patient with Cushing syndrome which lab values should the nurse correlate with this condition glucose 170 the nurse is evaluating the side effects of the prescribed medications propylthiouracil for a client diagnosed with hyperthyroidism. Which cm should the nurse immediately report to PCP Increase in peripheral pulses with cracks in the lungs the nurse is caring for a newly admitted client diagnosed with thyroid storm which of the following action should the nurse take immediately administer prescribed propranolol nurse is visiting a client who has hypothyroidism and has been taking levothyroxine for 3 weeks. It is a priority for the nurse to follow up if the client says what? sometimes my heart feels like it is racing and I get dizzy and lightheaded caring for a patient diagnosed with adrenocortical deficiency (Addison's disease). about a new prescription for hydrocortisone which is an adverse effect to the medication? immunosuppression Assessing a client who is 4 hours postoperative from a thyroidectomy and is demonstrating spasms of the arm when bp is taken the nurse should prepare to immediately administer iv calcium gluconate The nurse is admitting a client who is at risk for myxedema coma. Which of the following interventions should the nurse include as a priority in the clients care plan Avoid the use of hypnotic and sedative medications assessing a client who has hyperthyroid and is at risk for developing a thyroid storm. it is necessary for the nurse to notify the PCP if the client has notably extreme tachycardia interviewing a client who has hyperparathyroidism which of the following client statements should the nurse correlate to this condition I didn't even know that I had this disease the nurse manager is observing a newly hired nurse provide dc instructions to a client newly diagnosed with adrenocortical insufficiency (Addison's disease). Which of the following statements by the newly hired nurse requires intervention by the nurse manager you will be prescribed blood pressure medications to be taken during a crisis The nurse is instructing a client who is scheduled to have a radioactive iodine uptake test which of the following client's statement indicate the correct understanding of the teaching this test is being performed to determine how well my thyroid gland functions caring for a client who has hyperparathyroidism it requires immediate follow up if the patient reports discomfort in the flank area of the back the nurse has instructed a client who has hyperthyroidism and has been prescribed propylthiouracil which of the following client statements indicates a correct statement of the teaching I need to pay attention to my intake of walnuts, soybean flour, cottonseed meal, and dietary fiber Caring for a client diagnosed with Cushing syndrome who is scheduled for a dexamethasone suppression test. During the test the nurse should administer 1 mg dexamethasone orally at night and obtain serum cortisol levels in the morning client calls and reports palpable firm but painless cervical nodes the client denies any recent infection which should the nurse do next refer client to the PCP for further evaluation the nurse is preparing to teach a client dx with multiple myeloma. Which of the following should the nurse include? daily water intake should be increased to maintain a high urine output The nurse is caring for a patient who is diagnosed with leukemia the client has ecchymosis on the sacral area and petechiae on the forearms which of the following actions should the nurse take FIRST check the most recent platelet count nurse is caring for a client who has advanced myeloma which of the following complications should the nurse consider when planning client care risk for fracture or spinal cord compression caring for a client who is scheduled to have a bone marrow aspiration and tells the nurse that they are afraid about the pain involved with the procedure which of the following is an appropriate statement by the nurse You will feel some brief sharp pain, but the feeling is mostly a pressure sensation the nurse is teaching a client who is diagnosed with Hodgkins lymphoma. The client asks the nurse why it is even necessary to stay out of the sun stop drinking and stop smoking I already have the disease which is the best response by the nurse it is important to keep reducing the risk factors for developing different types of cancers the nurse manager is providing education to nursing staff about IV chemo which of the following statements made by the staff member indicates a need for additional teaching. if the antidote is given for peripheral extravasation the client will not experience tissue damage the nurse preceptor is observing a newly hired teach a client diagnosed with acquired immune deficiency syndrome {AIDS) about the prevention of infection at home. which of the following statements by the newly hired nurse requires immediate intervention by the nurse preceptor. you need to brush your tongue to remove any white patches teaching a 32 year old female who has systemic lupus erythematosus (SLE) about self care practices. which of the following client statements indicates the need for further teaching I should limit my exposure to direct sunlight to only 20-minute intervals the nurse is caring for a client who is diagnosed with Rheumatoid arthritis and has rheumatoid nodules in both elbows which of the following actions should the nurse take assess the nodules for skin break down or infection the nurse is assessing a client who has systemic lupus erythematosus which of the following findings should the nurse expect to observe if the client is having an exacerbation worsening discoid rash on the skin and inflamed oral lesions The nurse manager is providing education on pneumocystis Jirovec pneumonia to nursing staff. Which of the following statements by a staff member indicates a correct understanding pf this topic the lab value most characteristic of this infection is hypoxemia the nurse is caring for a client who is receiving chemo which of the following nursing interventions should the nurse include in the plan of care monitor white blood cell count daily caring for a client who has been diagnosed with acute myeloid leukemia (AML). client is scheduled to start induction therapy the nurse should teach what neutropenic precautions the nurse is assessing fluid and electrolyte laboratory values for a client diagnosed with wasting syndrome due to acquired immune deficiency syndrome (AIDS) which lab value would the nurse report immediately K level of 2.8 the nurse is caring for a client diagnosed with acute lymphocytic leukemia. which of the following findings should the nurse expect to see in the client cranial nerves palsies severe headache and vomiting due to a meningeal involvement the nurse is preparing a client who has chronic myeloid leukemia for continued treatment at home which of the following is best for the nurse the emphasize to the client's family adhere to follow up medical appointments the nurse is caring for a client receiving IV chemo the client calls the nurse and states the chemo medication is leaking onto my bed which of the following actions by the nurse is appropriate for this situation wearing 2 pair of chemo gloves with the inner pair under thee gown sleeve nurse is caring for a client diagnosed with aids and whose weight is below normal bmi which intervention should the nurse implement allow the client to rest quietly or take a nap before meals the nurse is providing teaching to a client who is now in remission from non hodgkins lymphoma which of the following recommendations should the nurse include in the teaching exercising for 30 minutes 5 times a week the nurse is talking with a client who has rheumatoid arthritis the client tells the nurse that they are having difficulty taking their meds due to childproof medication lids. which of the following nursing actions best facilitate the client adheres to the mediation regimen recommend a referral for occupational therapy for assistive devices the nurse working in the ED is triaging a client who is suspected of reactivation of tb which of the following actions should the nurse take next obtain sputum specimens and monitor temperature